Inhalant Abuse Creativeresol-ve - PowerPoint Presentation

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Inhalant Abuse

Creativeresol-ve

Educational Company

Healthcare Training.

Simplified.

CEP #

15273

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Objectives

At the completion of this program, the learners will:

Define inhalants

Identify classes and examples of inhalants

Recognize reasons why youths are using inhalants

Acknowledge inhalant practices by gender and ethnicity

State methods of inhalation and the most frequent site of usage

Explain the effects of inhalants on the body

Define inhalant intoxication, withdrawal, tolerance and addiction

Identify emergency treatment

Recognize fatal and long-term consequences of inhaling

Correlate the relationship of inhalant abuse and delinquent behavior

List three clinical/nursing interventions to assist the patient who abuses inhalants

Complete exam components at a 70% competency

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Introduction

I

nhalant

abuse

is a growing trend and it can be challenging to recognize the early warning signs, which makes it more difficult to

treat.

There are an alarming number of youths inhaling chemicals for euphoric

purposes.

I

nhalants

are being used increasingly by preteen aged

children (5-6 years old).

These substances are physically and psychologically addicting and can cause death.

American Family Physician (AFP)

revealed that

about one-quarter of school aged children

'huff‘.

Nurses

need to be able to recognize the signs of inhalant abuse.

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Statistics from 2008 show a decline in the use of inhalants by youths. In the past decade there has been a concerted effort to educate healthcare professionals, educators, law enforcement, retailers, youths and parents about inhalants

.

Monitoring the Future (MTF)

is an ongoing study for the National Institute of Drug Abuse (NIDA) of the behaviors, attitudes, and values of American secondary school students, college students, and young adults.

Statistics

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MTF Data

Drug Usage

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Inhalant Usage

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Perceived Risk of Inhalants

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Prevalence of Inhalant Abuse

Most children and adolescents say they are aware of people who breathe in fumes of household

products.

The abuse of inhalants is widespread across the United

States but may be underreported

law enforcement officials and healthcare providers are often unfamiliar with the signs of inhalant abuse.

Inhalants are the 4th most abused substances in the United States among 8th, 10th, and 12th graders; alcohol, cigarettes, and marijuana are the top three according.

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 Facts about Inhalant Abuse

Start

by inhaling deeply and taking several more breaths.

sniffing or snorting chemical

vapor

directly from open containers

huffing fumes from rags that are soaked in a chemical substance and held to the face or stuffed to the mouth

spraying aerosols directly into the nose or mouth

pouring inhalants onto the user’s collar, sleeves, or cuffs

bagging or inhaling substances sprayed or deposited in a bag or plastic bag

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1.

Volatile solvents

are liquids that vaporize at room temperature when left in unsealed containers.

Categories of Inhalants

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Categories of Inhalants

2. Aerosols

are spray containers containing propellants and solvents such as

toluene.

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Categories of Inhalants

3.

Gases

are substances with no definite shape or volume. The most commonly abused gas, nitrous oxide, is found in whipped cream dispensers and products that boost octane levels in racing cars.

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Categories of Inhalants

4. Nitrites

which are mainly use to enhance sexual experiences. These are commonly available in adult bookstores and over the internet.

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Huffing

- inhaling

vapors from a cloth soaked in a volatile substance, which is

then

held over the mouth and nose.

Sniffing

-

inhaling vapors from an open

container

Spraying

-

implies spraying an aerosol directly into the

mouth

Bagging

-

placing the volatile substance into a plastic bag which is then

held over

the mouth and nose.

Abusers use several different techniques to inhale:

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Street Terms for Inhalants

Amys

Bolt

Bullet

Glading

Hardware

Hippie crack

Locker room

PoppersSnappers

Bang

Boppers

Climax

Gluey

Head Cleaner

Kick

Poor man’s pop

Rush

Toncho

(octane booster)

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When someone sniffs or huffs, the toxic gases rush into the

lungs.

the oxygen cannot reach the brain and suffocates the person who huffs the toxic

chemical.

They have direct effects on both central nervous system (brain and spinal cord) and the peripheral nervous system (nerves throughout the body)

Inhalant can be smelled on skin and breath.

Can cause permanent damage to the brain, nervous system, kidneys, liver, heart and muscles because toxic chemicals are stored in the body fat forever.

“sudden sniffing death”- most serious effect that leads to death.

What are the Effects

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Rapid Onset Effect

or “High”- reached within minutes of inhaling. This effect provides instant gratification to users.

Quality and Pattern of High-

euphoria

, giddiness, and

lightheadedness, surge of creativity and excitement.

Low Cost-

Poverty and lack of opportunity potentiate inhalant

use.

Easy to Conceal-

Youths frequently carry the product they abuse with them, often for use in the classroom or at social

functions.

Legality

-

Purchase and possession of these substances is not restricted or illegal in most areas

.

Easily available-

unlike other forms of drugs, these products are readily available from numerous retail stores.

Why are Inhalants Used?

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Some nitrite abusers (who tend to be adults rather than adolescents) seek to enhance the sexual experience. Inhaled nitrites dilate blood vessels, increase the pulse rate, and produce a sensation of heat and excitement that can last several minutes.

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Characteristics of Users

Parents frequently deny the possibility that their child has used inhalants.

Such youths may have the following characteristics

:

Emotional stress

-

crisis has recently occurred either at school or at

home

Dysfunctional Home

-

one or both parents use alcohol or

drugs

Risk taker

-

Youths are frequently risk takers and use inhalants even though they have heard of the detrimental effects

.

Low self

esteem-

often vulnerable to peer pressure.

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Gender and Inhalant Use

Inhalants were considered a drug abused by males yet according to studies, there is a continued increase of inhalant use among females.

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Ethnicity

In the 80’s typical

user of inhalants

are

Native American or Hispanic

males.

New data has found that there is a strong pattern of decreases in inhalant use among Native American adolescents over the last decade

.

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Where do Inhalers Use?

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Transient social abusers tend to be preteens or teenagers who use substances in the presence of others. Legal problems include minor offenses while

intoxicated.

Transient isolate abusers are in the same age group but tend to abuse solvents while alone. This group is unlikely to have legal problems.

Transient abusers have a short-term history of

abuse

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Chronic social abusers tend to be in their 20’s and 30’s and have used substances in the presence of other for years. Legal problems include

misdemeanors

Chronic isolate abusers are in the same age group, but abuse drugs while alone. Legal problems include significant offenses including assaults.

Chronic abusers of inhalants

started using

inhalants early in

life and have chosen a certain inhalant as their drug of choice.

Chronic abusers have used for

years

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Signs of Use

Unusual breath odor or chemical odor on clothing

Sitting with a pen or marker near the nose

Slurred or disoriented speech

Anxiety, excitability, irritability or restlessness

Drunk, dazed or dizzy appearance

Constantly smelling clothing sleeves

Showing paint or stain marks on the face, fingers or clothing

Hiding rags, clothes or empty containers (such as air fresheners) of the potentially abused products in closets and other places

Signs of paint or other products where they wouldn’t normally be, such as on the face or fingers

Red or runny eyes or nose

Spots or sores around the mouth

Nausea or loss of appetite

Lack of coordination

Nausea or loss of appetite

Failing grades, chronic absence and general apathy

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W

ithdrawal

syndrome

can

begin 24-48 hours after cessation of use and last from 2 to 5 days

.

Symptoms include:

Sleep disturbances

Tremor

Irritability

Diaphoresis

Nausea and fleeting illusions

Headaches or abdominal cramps (youths)

Additional symptoms exhibited by

long-term

inhalant abusers include weight loss, muscle weakness, disorientation, inattentiveness, irritability, and

depression.

Withdrawal- Tolerance- Addiction

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Sweating

Rapid pulse

Hand tremors

Insomnia

Nausea

Vomiting

Grand mal seizures

Liver disease (hepatitis or cirrhosis)

Acute or chronic renal failure

Sleep disturbances

Bone marrow depression

Cardiac arrhythmias

Respiratory damage (lung or sinus damage, pneumonitis, emphysema, ling changes or respiratory depression

)

Withdrawal symptoms (long-term use)

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Assessment

Careful assessment of persons who are potentially using inhalants is vital in helping individuals avoid the serious

complications.

Clients can be encountered in a number of health care

settings (schools, clinic, psychiatric/addiction counseling environments, emergency rooms and acute care settings).

The assessment process should include a

history

,

physical

,

psychological

and

diagnostic

evaluation.

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The quality and quantity of data elicited will depend on the practitioner’s sensitivity to the client.

Information

must be collected on the inhalant abused; the manner, duration, and frequency of abuse, and the use of other chemicals (alcohol).

It is recommended that the person who is performing the assessment obtain information pertaining to childhood disease, history of injuries and acute or chronic infections (including STDs).

Change in

behavior

or attendance at school; teachers will frequently report a change in grades or conduct in the classroom

Arrest for substance abuse offense.

Youths frequently display deviant, disruptive or delinquent

behavior

Personality changes

History

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It should include objective and subjective data. The following systems should be

assessed:

Cardiovascular-

After a solvent is inhaled, a peripheral vasodilatation results, with variable degrees of hypotension and reflex

tachycardia.

Chronic exposure to volatile substances may cause dilated cardiomyopathy or myocarditis and additionally cases of cardiac arrhythmias and myocardial

infarction.

Neurologic

-

Cerebral cortex damage can cause changes in personality, memory loss, hallucinations and learning problems. Cerebellum damage can cause problems in balance and movement. Hippocampus damage may result in memory problems. Peripheral neuropathy has been reported secondary to chronic inhalant

abuse.

Respiratory

-

Coryza, pharyngitis, and pulmonary failure from aspiration are consequences of inhaling.

Rales

, rhonchi, bronchitis and pneumonia may be noted. The diagnosis of Inhalant abuse is often missed, and the respiratory condition may be treated without an evaluation of the

cause.

Physical Assessment

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Gastrointestinal

-

Nausea, vomiting, and abdominal pain may be noted during intoxication and withdrawal. Manifestations of chronic abuse include anorexia and weight loss. Impaired liver function may be

noted.

Musculoskeletal

- Muscle weakness has been noted from using products that contain toluene, such as lacquer

thinner

Urological

- The renal tubules may suffer damage from inhalants, altering electrolyte

levels.

Hematology

- Bone marrow depression is a complication of inhalant abuse. Toxic effects of inhalant abuse include anemia, thrombocytopenia, leukemia, and

hemolysis

HEENT-

Huffing causes sores or a rash in and around the mouth. Sniffing

causes chronic nosebleeds and sores in the nose. Freezing of the lips and mouth can occur when the substance is inhaled directly from a

cylinder.

. Other manifestations include tinnitus, sneezing, hyper salivation and

conjunctival

irritation.

Physical Assessment

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Psychological Assessment

The inhalant abuser may appear apathetic or belligerent and exhibit impaired judgment. Other behaviors to observe: Difficulty concentrating

Irritability

Depression

Apathy

Hostility

Violent temper outbursts

Paranoia

Hallucinations Anxiety

Lack of motivation

Mood swings

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Specific questions should be asked in the following areas

:

Previous suicidal ideation/plan

Actual suicide attempts in past (dates and methods)

Current suicidal ideations/plan

Previous psychiatric care/current psychiatric care

Symptoms of depression

Recent loss of significant others, including pets

Feelings of hopelessness/helplessness

Sleep and appetite disturbances

Social withdrawal

Psychological Assessment

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Diagnostic Evaluation

Inhalant users should be assessed with computed tomography (CT) and magnetic resonance imaging (MRI) studies of the brain. New research suggests inhalants also dissolve the myelin sheath of neurons in the

brain.

R

outine

drug screen is recommended to rule out other drugs

.

Laboratory identification of inhalant abuse most often requires analysis of body fluids by gas

chromatography.

A complete blood count (CBC) should be performed to determine if any of the following are present: infection, anemia, leukocytosis, thrombocytopenia, thrombocytosis, or platelet

defects

Creatinine, blood urea nitrogen (BUN) and urinalysis to assess kidney

function.

Serum electrolytes should be assessed to determine if there is an electrolyte imbalance such as

hypercholeremia

, hypokalemia and

hypophosphatemia.

Electrocardiogram (ECG) and chest x-ray should be used to determine heart and lung

damage

Visual and auditory-evoked potentials are abnormal in children

Neuropsychologic

testing is recommended

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Death from using inhalants can occur from several factors:

Injury

-

Impaired judgment is a consequence of inhalant abuse.

Asphyxiation and Suffocation

-

Asphyxiation is caused from repeated

inhalations

displacing the available oxygen in the lungs. Suffocation occurs from blocking air from entering the lungs when

inhaling.

Choking

- Users can choke on their own

vomit.

Suicide-

the inhaler passes out from the inhalant and suffocates to

death.

Sudden

death-

caused from a cardiac

arrhythmia. “

Sudden sniffing death

” is the sensitizing of heart to a rush of adrenaline combined with the inhalant used which causes the heart to stop instantly. This is responsible for more than half of all deaths to inhalant abuse.

Fatal Consequences of Inhalant

Use

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Kaposi’s Sarcoma-

Amyl and butyl nitrates have been associated with Kaposi’s sarcoma, the most common cancer reported with AIDS patients.

This is due to use of volatile nitrates.

Long-term Consequences

Inhalant Induced Persisting Dementia

-

This disorder is termed "persisting" because the dementia persists long after the individual has experienced the effects of inhalant intoxication and

withdrawal.

T

here

must be evidence from the history, physical exam or laboratory findings that the deficits are etiologically related to the persisting effects of inhalants.

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Long-term Consequences

Burns-

Inhalants cause impaired judgment.

The

highly flammable nature of inhalants

leads to burns.

Development Harm to

Fetuses

-

Abuse of inhalants during pregnancy may place infants and children at increased risk of developmental harm.

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Children could have

evidence of retardation in growth and development and residual deficits in cognitive, speech, and motor

skills.

It is recommended that infants born to women who have recently used inhalants be observed carefully for an alcohol-like withdrawal

syndrome

I

nhalant

abuse places children at increased

risk.

P

renatal

exposure to toluene or

trichlorethylene

(TCE) can result in reduced birth weights, occasional skeletal abnormalities, and delayed neurobehavioral

development.

A number of case reports note abnormalities in newborns of mothers who chronically abuse solvents. There is also evidence of subsequent developmental impairment in some of these children.

Developmental harm to fetuses

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More minor criminal activity has been reported among inhalant

users. The findings suggest that inhalant use is categorically different from other drug use, and that it has more in common with general delinquency than with general drug use.

Delinquent Behavior & Inhalant Use

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Addiction Treatment Effectiveness

Treatment facilities for inhalant abusers are hard to find.

Program directors of drug user treatment programs perceive a great deal of neurological damage incurred through inhalant use. They also have a general pessimism about treatment effectiveness and recovery.

Detoxification averages 40 days and treatment for inhalant abusers is usually long-term, sometimes as long as 2 years.

Detoxification must also include:

Support of the child's family

Moving the child away from unhealthy friendships with other abusers

Teaching and fostering better coping skills

Building self-esteem and self-confidence

Helping the child adjust to school or another learning setting

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Relapse

Inhalant abusers have high relapse rates, making aftercare and follow-up extremely important

.

The warning signs of relapse include

:

returning to old

habits

Friends

hangouts or

denial

The following are recommended:

Aftercare

-

includes a structured plan for relapse prevention and active participation in treatment issues

.

Support Group

-

Groups such as NA or AA use a 12-step approach to help the recovering person develop a different life style.

Sponsor

-

a recovering person who is always available to the new member by telephone for encouragement, for clarification, and as a sounding board, particularly during the early stages of recovery.

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General Clinical/Nursing Interventions

During the acute phase of inhalation intoxication and detoxification, care focuses on maintaining the patient's vital functions, ensuring his/her safety, and easing discomfort.

During

the rehabilitation, caregivers help the patient acknowledge his/her substance abuse problem and find alternative ways to cope with stress

.

C

linical/nursing

interventions

during and after acute intoxication:

During an Acute Episode

Continuously monitor the patient's vital signs and urine

output

Maintain a quiet safe environment. Remove harmful objects from the

room.

Institute appropriate measures to prevent suicide attempts and

assaults

Approach the patient in a nonthreatening

way. Limit sustained eye contact.

Implement seizure precautions

Give medications, as ordered, monitoring and recording their

effectiveness. (Haldol, sedatives, anticholinergic and antidiarrheal agents, antianxiety)

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General Clinical/Nursing Interventions

2. During Drug Withdrawal

Administer medications, as ordered, to decrease withdrawal symptoms, monitoring and recording their effectives

Maintain a quiet, safe environment because excessive noise may agitate the patient.

3. When the Acute Episode has Resolved

Carefully monitor and promote adequate nutrition

Administer drugs carefully to prevent hoarding. Check the patient's mouth to ensure that (s) he has swallowed oral medication.

Refer the patient for rehabilitation as

appropriate.

Encourage

family members to seek help regardless of whether the abuser seeks it.

Develop self-awareness and an understanding and positive attitude toward the patient.

Set limits when dealing with demanding, manipulative behavior

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Prevention is the Key

Prevention of inhalant abuse is the goal. This involves the entire community, including healthcare professionals, teachers, parents, peers, law enforcement and retailers. This section provides information for nurses to assist in the education of others.

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Teaching children about inhalants

Children need to be able to differentiate between "good smells" (i.e., cookies baking). and "bad smells" (i.e., gas).

Six

year-old children are not too young to be taught the dangers of inhalants.

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Parents frequently deny that inhalants could be a problem in their families, schools or communities

.

The

American Academy of Pediatrics recommends that the best way to fight inhalant abuse is to educate children about how harmful these products are.

Parents and teachers should also be able to recognize the warning signs of inhalant abuse

.

Talking to parents about inhalants

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Suggestions

Do not shut children out by simply saying something is 'bad for you'.

Educate yourself and then give your child the right information.

Talk about dangerous behavior, such as inhalant abuse, and explain the consequences.

Help your child develop refusal skills—how to say 'no'.

Listen to your child

Ask your child questions such as 'where are you going?' or 'who will you be with

If you think your child is into inhalant abuse, remain calm. Upsetting them may make them more violent or trigger a physical response such as sudden sniffing death.

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Classes and Examples of Inhalants

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Diagnostic criteria for 292.89--Inhalant Intoxication

The following is the American Psychiatric Association (APA) DSM-IV-TR (2000

):

Recent intentional exposure to short-term, high dose volatile inhalants (excluding anesthetic gases and short-acting vasodilators

)

Clinically significant maladaptive behavioral or psychological changes that developed during, or shortly after, use of or exposure to volatile

inhalant.

Two (or more) of the following signs, developing during, or shortly after, inhalant use or exposure:

Dizziness,

Nystagmus

, Incoordination,

Slurred

speech,

Unsteady

Gait, Lethargy,

Depressed

reflexes,

Psychomotor

retardation, Tremor,

Generalized muscle

weakness,

Blurred vision or

Diplopia,

Stupor or

Coma, Euphoria

The

symptoms are not due to a general medical condition and are not better accounted

for by

another mental disorder.

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Emergency

Treatment

Medical

Airway Management-

Prevention of aspiration is essential. High-flow oxygen via

a

mask or by endotracheal tube is

recommended, if indicated.

Vital

signs and cardiac monitoring

;

IV for hydration and access for administration of emergency

drugs

Calm environment- Inhalants cause an increased release of

catecholamines

leading

to increased heart rate and blood pressure.

In the event of accidental ingestion of an inhalant, it is recommended that a nasogastric tube be placed and aspirate the stomach contents within one hour of

ingestion.

Medication-

There is no recommended medication for withdrawal of inhalant abuse

. However, individual symptoms can be treated with medication for manifestations of inhalation abuse.

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Mental Health

Psychological and addiction

evaluation-

denial is

a

common symptom of addiction

.

The abuser may be anxious to

convince

healthcare personnel that they will never abuse inhalants

again.

A psychological evaluation is necessary to rule out concurrent mental health problems.

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Conclusion

Inhalant abuse is

growing

and

frightening problem

that can

be challenging to recognize early.

Easy accessibility and the relatively low cost of the substances

will

attract new users and continue to be a problem

.

inhaling may lead to addiction or other drug

usage.

The most effective way to prevent inhalant abuse is by educating providers, healthcare workers, teachers, and parents.

Parents may not realize that they have only a few short years in which they can influence their child’s decision not to abuse inhalants.

It is important that nurses have full access to information that would help them identify inhalant abuse.

Nurses need to take the leadership in assessing youth, in educating other health care professionals, educators and the public

.

Nurses need to play an integral role in identification, prevention and education.

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